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Technical Innovation |
1 Department of Radiology, Wake Forest University School of Medicine, Medical
Center Boulevard, Winston-Salem, NC 27157-1088.
2 Department of Cancer Biology, Wake Forest University School of Medicine,
Winston-Salem, NC, 27157-1088.
3 Department of Urology, Wake Forest University School of Medicine,
Winston-Salem, NC 27157-1088.
Received October 9, 2002;
accepted after revision December 24, 2002.
Address correspondence to R. J. Zagoria.
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Fifty-two months after the nephrectomy, the patient began experiencing significant nausea, vomiting, and abdominal pain. Physical examination was unremarkable. Abdominal sonography revealed a 3.6 x 4.8 cm left retroperitoneal mass suggesting a recurrence. CT of the abdomen revealed a 5.5 x 7.0 cm heterogeneously enhancing mass in the region of the left renal fossa (Figs. 1A and 1B). The mass abutted the abdominal aorta and the superior mesenteric artery. CT-guided fine-needle and core needle biopsies of the mass confirmed the diagnosis of recurrent renal cell carcinoma.
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The patient was evaluated in the hematology and oncology clinic. Given the close proximity of the mass to the abdominal aorta, the tumor was determined to be unresectable. Thus, the decision was made to treat the tumor with radiofrequency ablation. The patient was referred to the department of radiology for percutaneous ablation.
CT-guided percutaneous radiofrequency ablation of the renal mass was performed while the patient was under general anesthesia. Using a cool-tip cluster electrode 20 cm in length with a 2.5-cm active tip, we performed three geographically separate ablations of the tumor. The temperature at the electrode tip exceeded 70°C after each ablation. The patient tolerated the procedure well, and a postprocedure CT revealed no evidence of complications or of tumor enhancement. The patient was discharged the following day in good condition.
In the 16 months after the ablation, the patient underwent follow-up CT studies of the abdomen every 3 months. At 6 weeks after the procedure, the CT scan revealed a reduction in the size of the mass to 4.8 x 3.8 cm and the absence of enhancement within the mass (Fig. 1B). At 14 months after the procedure, the CT scan revealed further decrease in the size of the nonenhancing mass (Fig. 1C). At 16 months, CT performed at an outside institution revealed further reduction in the size of the mass with a continued absence of enhancement. There has been no evidence of recurrence or metastases, and the patient remains asymptomatic.
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Percutaneous radiofrequency ablation is a minimally invasive treatment for isolated neoplasms. This technique involves sonographically or CT-guided placement of an electrode. The ablation electrode is connected to a monopolar radiofrequency generator, and the energy is transmitted through the electrode tip. The energy generates heat, and heat in excess of 50°C causes protein denaturation and cell membrane disruption. This damage results in immediate cell death and destruction of the tumor.
Radiofrequency ablation has been used effectively to treat focal malignancies throughout the body [7, 8]. Given the minimally invasive nature of the procedure and the low rate of complications, radiofrequency ablation is frequently used to treat patients who are not surgical candidates [9]. Previously, this therapy has been used in the treatment of both primary and secondary renal cell carcinomas [7, 9]. Thus, it follows that this therapy would also be effective in the treatment of isolated local recurrences of renal cell carcinoma. Our experience supports this view, because this patient remains without radiographic evidence of disease 16 months after tumor ablation. Radiographic findings of no contrast enhancement and tumor shrinkage or stability have been shown to correlate with histologic findings of complete tumor ablation [10]. Further study will be necessary to determine which patients would be the best candidates for this technique as an alternative for surgery, but the initial result appears promising.
In conclusion, radiofrequency ablation may be a safe and minimally invasive alternative to surgery in the treatment of unresectable local recurrences of renal cell carcinoma. However, guidelines for determining which patients should undergo this procedure have not yet been developed. Further studies are needed to determine the long-term efficacy of this modality before radiofrequency ablation can be recommended as an alternative to aggressive surgical treatment of isolated locally recurrent renal cell carcinoma.
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  R. J. Zagoria Imaging-guided Radiofrequency Ablation of Renal Masses RadioGraphics, October 1, 2004; 24(suppl_1): S59 - S71. [Abstract] [Full Text] [PDF]
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 A. Hines-Peralta and S. N. Goldberg Review of Radiofrequency Ablation for Renal Cell Carcinoma Clin. Cancer Res., September 15, 2004; 10(18): 6328S - 6334S. [Abstract] [Full Text] [PDF]
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